Determinants of Child Malnutrition in Mauritania Yahya Abou Ly Research Paper 391 RICAN ECONOMIC RESEARCH CONSORTIUM RESEARCH ECONOMIC RICAN SORTIUM POUR LA EN AFRIQUE ÉCONOMIQUE SORTIUM RECHERCHE AF CON Bringing Rigour and Evidence to Economic Policy Making in Africa Determinants of Child Malnutrition in Mauritania By Yahya Abou Ly Cheikh Anta Diop University Dakar, Senegal AERC Research Paper 391 African Economic Research Consortium, Nairobi January 2020 THIS RESEARCH STUDY was supported by a grant from the African Economic Research Consortium. The findings, opinions and recommendations are those of the author, however, and do not necessarily reflect the views of the Consortium, its individual members or the AERC Secretariat. Published by: The African Economic Research Consortium P.O. Box 62882 - City Square Nairobi 00200, Kenya ISBN 978-9966-61-084-3 © 2020, African Economic Research Consortium. Contents List of tables Abstract Résumé 1. Introduction 1 2. Literature review 5 3. Methodology 10 4. Findings 17 5. Conclusion and policy recommendation 26 Notes 28 References 29 Appendixes 33 List of tables 1. Characteristics of the Multiple Indicator Cluster Survey, Mauritania 15 2. Mean of anthropometric indicators of children in Mauritania 18 3. Malnutrition according to characteristics (as a percentage) 19 4. Determinants of the nutritional state of children 22 Appendix 1. Descriptive statistics of Multiple Indicator Cluster Surveys 2007 33 and Multiple Indicator Cluster Surveys 2015 2. Proportion of children suffering from chronic malnutrition according 35 to various socio-demographic characteristics, Multiple Indicator Cluster Surveys-2007 3. Proportion of children suffering from chronic malnutrition according 36 to some socio-demographic characteristics Multiple Indicator Cluster Surveys 2015 4. Determinants of the nutritional state of children: Girls vs boys 37 5. Determinants of the nutritional status of children: Rural vs urban 38 Abstract The empirical context of this research is in an environment where malnutrition is a real public health concern. The objective of this study was to identify the determinants of the nutritional state of children under the age of five years in Mauritania. Using data obtained from multiple indicators cluster surveys (MICS) in Mauritania in 2007 and 2015, we undertook fixed-effects clusters techniques to control for unobserved heterogeneity. The empirical results demonstrate that the age and sex of a child, level of education of the mother, the standards of living of the household, the area of residence, the availability and use of health care services and access to drinking water are all important factors for the good health of children in Mauritania. These findings suggests improvements in nutritional health, for example, by education of girls until completion of secondary school; an improvement in the conditions of households that are headed by women and an expansion in the coverage rate of multi-purpose health centres. Key words: State of health, fixed effect clusters, anthropometric measurement, size- for-age, z-score. JEL codes: I12, I21, C26, J13 Résumé Le contexte empirique de cette recherche se situe dans un environnement où la malnutrition constitue une réelle préoccupation de santé publique. L’objectif de cette recherche est d’identifier les déterminants de l’état nutritionnel des enfants de moins de cinq ans en Mauritanie. À partir des données des enquêtes MICS pour la Mauritanie de 2007 et de 2015, nous avons procédé à des techniques à effets-fixes clusters pour contrôler l’hétérogénéité inobservable. Les résultats empiriques ont pu montrer que l’âge et le sexe de l’enfant, le niveau d’éducation de la mère, le niveau de vie du ménage, le milieu de résidence, la disponibilité ainsi que l’utilisation des services de soins de santé sont autant des facteurs importants pour la bonne santé des enfants en Mauritanie. Ces résultats suggèrent que l’amélioration de la santé nutritionnelle pourrait passer, par exemple, par une scolarisation des filles jusqu’à la fin du cycle secondaire ; une amélioration du sort des ménages dirigés par des femmes et un élargissement du taux de couverture des centres de santés polyvalents. Mots clés : état de santé, effets-fixes-clusters, mesures anthropométriques, taille pour âge, z-score. Codes JEL: I12, I21, C26, J13 DETERMINANTS OF CHILD MALNUTRITION IN MAURITANIA 1 1. Introduction The fight against poverty is key in ensuring the economic and social development of a country. Its analysis has been the subject of several debates and controversies in terms of the extent of the problem and its conceptualization. The well-being of individuals is necessary in order to ensure sustainable development. This vision has been widely shared in the Millennium Development Goals (MDGs) and in the sustainable development objectives. This study is formulated within that framework and attempts to explore one of the non-financial aspects of well-being, namely human capacity and, more specifically, health. Statement of the problem Schultz (1961) and Becker (1965) were among the first people to introduce the concept of human capital in economic theory. This concept is understood as the amount of productivity and general well-being available to an individual in a given society. It has an education component (initial and continuous training, and a set of aptitudes, and a health component (Mushkin, 1962). In regard to economic research that has paid particular attention to the long-term effects of the living conditions of children, Grossman (1972) also pays particular attention to investment decisions relating to the health of adults. In regard to infants, empirical studies have highlighted the effect of socioeconomic, demographic and environmental factors on the health status of children (Sahn, 1990; Handa, 1999; Tharakan and Suchindran, 1999). Literature has often associated the result of a low supply and a low level of accessibility to food resources to a phenomenon of human incapacity in regard to sufficient nutrition. This situation of nutritional imbalance leads to malnutrition. Malnutrition is the most common illness among the children under the age of 5 years. It is also common in developing countries and has a significant impact in terms of delayed physical and cognitive development, morbidity, mortality, and in terms of scholarly performance and productivity (Sahn and Alderman, 1988). The World Health Organization (WHO) defines malnourishment as a pathological state that is a result of deficiency or excess in relative or absolute terms in regard to various essential nutrients. This definition allows us to distinguish between three forms of malnutrition: malnutrition by excess (overeating); undernourishment (eating insufficiently); and nutritional deficiency (eating poorly or in an unbalanced manner) generally 1 2 RESEARCH PAPER 391 considered as one of the most alarming forms in several developing countries. Food deficiency is caused by a poor diet and inadequate health care. It is characterized by anthropometric (height and weight of the infant), chemical and biological symptoms. Consequently, undernourishment is a global problem that affects most regions. In absolute terms, 243.2 million people in the world did not have adequate dietary energy intake (FAO, 2017). The number of people suffering from undernourishment has sharply increased since 2014, increasing from 775 million in 2014 to 815 million in 2016 (FAO, 2017). Undernourishment is much more pronounced in Africa than in other regions of the world. Indeed, its occurrence is 20% in Africa whereas it is 11.7% in Asia and 2.5% in North America and Europe (FAO, 2017). Sub-Saharan Africa also remains the region that is most affected by this phenomenon with a prevalence rate of 22.7% in 2016. Global statistics on nutrition show that the problem of malnutrition remains unresolved and the various forms of malnutrition are still alarming. The Nutrition Global Report (FAO, 2017) indicates that in 2016 a total of 155 million children suffered from stunting (22.9%,), 52 million were emaciated (7.7%), two billion suffered from deficiency in terms of essential micronutrients, such as iron and vitamin A, and twobillion infants were overweight (6%). In Mauritania, problems related to malnutrition are equally worrisome. Pregnant and nursing women and children under the age of five years are the most affected by this phenomenon (WFP, 2015). Nutritional effects are evident at several levels, especially in children under the age of five. The report on the cost of hunger in Mauritania (CEA, 2014) shows that: • The number of children suffering from malnutrition in terms of being underweight has increased; • 43% of the active population suffers from stunted growth during their childhood; • Mauritania lost 13.3% of its GDP due to the cumulative effects of stunted growth on productivity; • 4.5% of infant mortality in Mauritania is related to undernourishment; • Children affected by stunted growth achieve 2.4 school years less than those who did not suffer from malnutrition. In light of this scourge affecting children, public authorities have taken initiative by adopting in 2005, the National Nutrition Development Plan (PNDN). This programme includes the Integrated Management of Acute Malnutrition (PECIMA) and the fight against deficiency in micronutrients as well as operations for the monitoring of children. In regard to the National Health Development Plan (PNDS) 2012–2020, the major objective is to reduce among other things: